Short, low-dose opioid prescriptions may increase youths’ risk for persistent use

Short and low-dose opioid prescriptions may increase risk for persistent use among high-risk youths, according to results of a cohort study published in JAMA Network Open.

“This study helps identify patterns of opioid use following the first opioid prescription for a young cohort of adolescents and young adults,” J. Deanna Wilson, MD, MPH, of the departments of medicine and of pediatrics at the University of Pittsburgh School of Medicine, told Healio Psychiatry. “It helps us identify that while the majority of young people fall into low-risk trajectories, there is a small number of youths at very high risk for complications from the first opioid prescription. Providers should discuss with youths and their families the risk for opioid-related complications and ways to mitigate that risk, such as having parents monitor administration or dispose of unused opioid prescriptions.”

According to the researchers, prior studies tended to assess population-level risks after the first opioid prescription, leaving a lack of research into how opioid prescribing patterns after first opioid exposure may affect long-term risks. In the current study, Wilson and colleagues aimed to determine distinct opioid prescribing patterns after the first prescription via group-based trajectory modeling, as well as the assess factors on the patient, clinician and prescription levels that were potentially linked to trajectory membership in the first year. They analyzed data of 189,477 individuals (female, 56.8%; median age, 16.9 years) aged 10 to 21 years at time of first opioid prescription who had available Pennsylvania Medicaid enrollee claims data between 2010 and 2016.

Results showed a total of 47,477 participants received one or more additional prescriptions in the subsequent year. A two-group trajectory model had the best fit among those considered. A total of 901 (65.3%) of participants in the high-risk trajectory filled opioid prescriptions at month 12 compared with 6,031 (13.1%) participants in the low-risk trajectory. Those in the high-risk trajectory had a median age of 19 years compared with 17.8 years in the low-risk trajectory. The researchers noted more potent prescriptions in the high-risk trajectory vs. the low-risk trajectory. More youths in the high-risk trajectory (30%) went on to receive an opioid use disorder diagnosis compared with the low-risk trajectory (10.1%).

“The key take-home message is that even short, fairly low-dose opioid prescriptions are not without risks for some youths,” Wilson said. “We see a high proportion of those in the higher risk trajectory that go on to receive a formal diagnosis of opioid use disorder, suggesting they have an addiction or problem with opioids. Although this number is small relative to the overall sample of young people prescribed opioids, it suggests that that first opioid prescription may be associated with problems even several years later for the most vulnerable group of youths.”

In a related editorial, Maria H. Rahmandar, MD, of the Substance Use & Prevention Program at the Ann & Robert H. Lurie Children’s Hospital of Chicago, and colleagues noted considerations for efforts to address youth opioid misuse.

“As we strive to intervene in this deadly opioid crisis, we should continue with compassionate treatment of pain together with efforts to address substance misuse,” the authors wrote. “We need to avoid swinging the pendulum too far in the opposite direction so as not to leave people ignored and in need of help. This is particularly true in the context of the COVID-19 pandemic, which has hit teens particularly hard.”